The ACLU is currently tracking over 400 anti-LGBTQ bills this legislative session, the highest number on record. Over 150 of these pertain to transgender people, including many targeting health care for transgender youth.
As of April 2023, thirteen states have passed laws or policies banning gender-affirming care for youth, while more than fifteen others have introduced similar bills and policies. These actions may forbid or criminalize evidence-based medical treatment for gender dysphoria, label such interventions as a form of child abuse, and/or impose penalties, including felony charges, on health care professionals who provide or refer for this care. The Human Rights Campaign reports that over half of transgender youth, ages 13 to 17, have lost or are at risk of losing access to medically necessary gender-affirming care in their state.
Some of these bills may extend limitations on gender-affirming care to transgender young adults aged 18 to 26, including Texas, Oklahoma, and South Carolina. Alternatively, these bills may attempt to outlaw gender-affirming care for all patients by restricting reimbursement for health care providers or prohibiting public funds to cover such treatments. This sets a dangerous precedent and opportunity for the conservative proponents of these bills to expand bans to gender-affirming care for all patients.
Research has shown that these bills go against medical recommendations for gender-affirming care, including those published by the World Professional Association for Transgender Health, Endocrine Society, and the American Academy of Pediatrics, and exacerbate already existing health disparities for this vulnerable population. Transgender youth experience significantly higher rates of suicide compared to their cisgender peers – The Trevor Project found that more than half of transgender and non-binary youth had seriously considered attempting suicide in the past year. Studies on transgender youth have demonstrated that those who receive gender-affirming hormone therapy or puberty blockers experience a decrease in symptoms of anxiety and depression, a reduction in suicidal thoughts, and an increase in appearance congruence, positive emotions, and overall life satisfaction.
Numerous national medical bodies, including but not limited to the American Medical Association and the American Academy of Pediatrics, are advocating against these legislative attacks. In addition, states such as Minnesota, Illinois, Vermont, and California have introduced and passed protective bills for patients and physicians seeking and providing gender-affirming care. However, the list of states with bans on gender-affirming care seems to grow longer and longer.
On the other hand, some countries in Europe, such as the United Kingdom, Sweden, Finland, and France, which were ahead of the U.S. on allowing medical interventions for gender dysphoria in youth, are now pulling back on what they allow. Countries like Denmark and Slovenia have allowed youth as young as 15 to obtain cross-sex hormone therapy. Many experts call for more long-term studies, but politicizing this care makes research in this area very difficult.
This legislative climate puts not only patients but physicians in jeopardy. In 2022, Boston Children’s Hospital and Akron Children’s Hospital received threats of violence due to the fact that these hospitals provide gender-affirming care for youth. Penalties against physicians in states such as Texas include felony charges for practicing gender-affirming care on youth.
Similar to the 2022 Supreme Court decision that overturned Roe v. Wade and is now impacting OB/GYN residency training, these bills and policies targeting gender-affirming care for transgender individuals can also have significant implications for medical training in LGBTQ health. Trainees in states with bans on gender-affirming care may miss out on critical training opportunities in this area. Furthermore, these policies may influence the decisions of transgender and non-binary pre-medical and medical students regarding which fields to pursue or where to live, as well as their sense of safety within health care settings. The potential threat of legal consequences, government interference in medical decision-making, and violence may also discourage aspiring health care providers from entering the field of transgender care altogether.
I believe that denying gender-affirming care to transgender youth is not only harmful but goes against the fundamental principles of medicine. As health care providers, it is our responsibility to ensure that all patients, including those who are transgender, receive evidence-based care that is tailored to their unique needs. Restricting access to gender-affirming care not only leads to negative health outcomes but perpetuates the stigma and discrimination faced by the transgender community. It is crucial that we, as health care providers, stand in solidarity with the transgender community and advocate for their right to access medically necessary care.
Carson Hartlage is a medical student.